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Bellini C, Pugliese F, Bicchierai G, Amato F, De Benedetto D, Di Naro F, Boeri C, Vanzi E, Migliaro G, Incardona L, Tommasi C, Orzalesi L, Miele V, Nori J. Contrast-enhanced mammography in the management of breast architectural distortions and avoidance of unnecessary biopsies. Breast Cancer 2024:10.1007/s12282-024-01599-x. [PMID: 38811515 DOI: 10.1007/s12282-024-01599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND To assess contrast-enhanced mammography (CEM) in the management of BI-RADS3 breast architectural distortions (AD) in digital breast tomosynthesis (DBT). METHODS We retrospectively reviewed 328 women with 332 ADs detected on DBT between 2017 and 2021 and selected those classified as BI-RADS3 receiving CEM as problem-solving. In CEM recombined images, we evaluated AD's contrast enhancement (CE) according to its presence/absence, type, and size. AD with enhancement underwent imaging-guided biopsy while AD without enhancement follow-up or biopsy if detected in high/intermediate-risk women. RESULTS AD with enhancement were 174 (52.4%): 72 (41.4%) were malignant lesions, 102 (59.6%) false positive results: 28 (16%) B3 lesions, and 74 (42.5%) benign lesions. AD without enhancement were 158 (47.6%): 26 (16.5%) were subjected to biopsy (1 malignant and 25 benign) while the other 132 cases were sent to imaging follow-up, still negative after two years. CEM's sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy were 98.63%, 60.62%, 41.38%, 99.37%, and 68.98%. The AUC determined by ROC was 0.796 (95% CI, 0.749-0.844). CONCLUSION CEM has high sensitivity and NPV in evaluating BI-RADS3 AD and can be a complementary tool in assessing AD, avoiding unnecessary biopsies without compromising cancer detection.
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Affiliation(s)
- Chiara Bellini
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesca Pugliese
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Bicchierai
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Amato
- Department of Radiology, Breast Imaging Unit, "Ospedale San Giovanni di Dio", Agrigento, Italy
| | - Diego De Benedetto
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuliano Migliaro
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ludovica Incardona
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cinzia Tommasi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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3
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Goh Y, Quek ST, Pillay P, Chou CP. Evaluation of architectural distortion with contrast-enhanced mammography. Clin Radiol 2024; 79:163-169. [PMID: 38114374 DOI: 10.1016/j.crad.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
Architectural distortion (AD) is the third most common abnormality detected on mammograms. In the absence of an accurate non-invasive tool to evaluate ADs, clinical management often requires surgical excision for histological diagnosis. This problem is expected to worsen with the growing use of digital breast tomosynthesis (DBT) and the resultant increasing detection of ADs. There is therefore a great clinical need for a diagnostic imaging tool to complement non-enhanced mammography for the evaluation of AD. Contrast-enhanced mammography (CEM) is an emerging breast imaging method that uses contrast media and the principle of dual-energy subtraction to evaluate vascularity of suspicious breast lesions. CEM, a cost-effective alternative to breast magnetic resonance imaging (MRI), can be used to evaluate AD by juxtaposing CEM images with non-enhanced mammograms for comparison. In this review, the authors aim to provide readers with an overview of the interpretation of AD on CEM using imaging examples. Relevant imaging features of CEM and their respective significance will be matched with information from a literature review. Finally, the authors would like to highlight the added value of CEM in relevant clinical applications in the assessment of AD.
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Affiliation(s)
- Y Goh
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - S T Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - P Pillay
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - C-P Chou
- Kaohsiung Veterans General Hospital, Radiology Department, No. 386, Dazhong 1st Rd, Zuoying Dist., Kaohsiung City 81362, Taiwan, ROC.
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Gauthier ID, Seely JM, Cordeiro E, Peddle S. The Impact of Preoperative Breast MRI on Timing of Surgical Management in Newly Diagnosed Breast Cancer. Can Assoc Radiol J 2023:8465371231210476. [PMID: 37965903 DOI: 10.1177/08465371231210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Purpose: Preoperative breast MRI has been recommended at our center since 2016 for invasive lobular carcinoma and cancers in dense breasts. This study examined how preoperative breast MRI impacted surgical timing and outcomes for patients with newly diagnosed breast cancer. Methods: Retrospective single-center study of consecutive women diagnosed with new breast cancer between June 1, 2019, and March 1, 2021, in whom preoperative breast MRI was recommended. MRI, tumor histology, breast density, post-MRI biopsy, positive predictive value of biopsy (PPV3), surgery, and margin status were recorded. Time from diagnosis to surgery was compared using t-tests. Results: There were 1054 patients reviewed, and 356 were included (mean age 60.9). Of these, 44.4% (158/356) underwent preoperative breast MRI, and 55.6% (198/356) did not. MRI referral was more likely for invasive lobular carcinoma, multifocal disease, and younger patients. Following preoperative MRI, 29.1% (46/158) patients required additional breast biopsies before surgery, for a PPV3 of 37% (17/46). The time between biopsy and surgery was 55.8 ± 21.4 days for patients with the MRI, compared to 42.8 ± 20.3 days for those without (P < .00001). MRI was not associated with the type of surgery (mastectomy vs breastconserving surgery) (P = .44) or rate of positive surgical margins (P = .52). Conclusion: Among patients who underwent preoperative breast MRI, we observed significant delays to surgery by almost 2 weeks. When preoperative MRI is requested, efforts should be made to mitigate associated delays.
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Affiliation(s)
- Isabelle D Gauthier
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jean M Seely
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Erin Cordeiro
- Department of Surgery, The Ottawa Hospital, General Campus, The University of Ottawa, Ottawa, ON, Canada
| | - Susan Peddle
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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5
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Endrikat J, Khater H, Boreham ADP, Fritze S, Schwenke C, Bhatti A, Trnkova ZJ, Seidensticker P. Iopromide for Contrast-Enhanced Mammography: A Systemic Review and Meta-Analysis of Pertinent Literature. Breast Cancer (Auckl) 2023; 17:11782234231189467. [PMID: 37600467 PMCID: PMC10433886 DOI: 10.1177/11782234231189467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/06/2023] [Indexed: 08/22/2023] Open
Abstract
Background Contrast-enhanced mammography (CEM) is an emerging breast imaging modality. Clinical data is scarce. Objectives To summarize clinical evidence on the use of iopromide in CEM for the detection or by systematically analyzing the available literature on efficacy and safety. Design Systematic review and meta-analysis. Data sources and methods Iopromide-specific publications reporting its use in CEM were identified by a systematic search within Bayer's Product Literature Information (PLI) database and by levering a recent review publication. The literature search in PLI was performed up to January 2023. The confirmatory-supporting review publication was based on a MEDLINE/EMBASE + full text search for publications issued between September 2003 and January 2019. Relevant literature was selected based on pre-defined criteria by 2 reviewers. The comparison of CEM vs traditional mammography (XRM) was performed on published results of sensitivity and specificity. Differences in diagnostic parameters were assessed within a meta-analysis. Results Literature search: A total of 31 studies were identified reporting data on 5194 patients. Thereof, 19 studies on efficacy and 3 studies on safety. Efficacy: in 11 studies comparing iopromide CEM vs XRM, sensitivity was up to 43% higher (range 1%-43%) for CEM. Differences in specificity were found to be in a range of -4% to 46% for CEM compared with XRM. The overall gain in sensitivity for CEM vs XRM was 7% (95% CI [4%, 11%]) with no statistically significant loss in specificity in any study assessed. In most studies, accuracy, positive predictive value, and negative predictive value were found to be in favor of CEM. In 2 studies comparing CEM with breast magnetic resonance imaging (bMRI), both imaging modalities performed either equally well or CEM tended to show better results with respect to sensitivity and specificity. Safety: eight cases of iopromide-related adverse drug reactions were reported in 1022 patients (0.8%). Conclusions Pertinent literature provides evidence for clinical utility of iopromide in CEM for the detection or confirmation of breast cancer. The overall gain in sensitivity for iopromide CEM vs XRM was 7% with no statistically significant loss in specificity.
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Affiliation(s)
- Jan Endrikat
- Radiology R&D, Bayer AG, Berlin, Germany
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | | | | | - Sabine Fritze
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Product Information, Bayer AG, Berlin, Germany
| | | | - Aasia Bhatti
- Benefit Risk Management Pharmacovigilance, Bayer US LLC, Whippany, NJ, USA
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Moffa G, Galati F, Maroncelli R, Rizzo V, Cicciarelli F, Pasculli M, Pediconi F. Diagnostic Performance of Contrast-Enhanced Digital Mammography versus Conventional Imaging in Women with Dense Breasts. Diagnostics (Basel) 2023; 13:2520. [PMID: 37568883 PMCID: PMC10416841 DOI: 10.3390/diagnostics13152520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this prospective study was to compare the diagnostic performance of contrast-enhanced mammography (CEM) versus digital mammography (DM) combined with breast ultrasound (BUS) in women with dense breasts. Between March 2021 and February 2022, patients eligible for CEM with the breast composition category ACR BI-RADS c-d at DM and an abnormal finding (BI-RADS 3-4-5) at DM and/or BUS were considered. During CEM, a nonionic iodinated contrast agent (Iohexol 350 mg I/mL, 1.5 mL/kg) was power-injected intravenously. Images were evaluated independently by two breast radiologists. Findings classified as BI-RADS 1-3 were considered benign, while BI-RADS 4-5 were considered malignant. In case of discrepancies, the higher category was considered for DM+BUS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, using histology/≥12-month follow-up as gold standards. In total, 51 patients with 65 breast lesions were included. 59 (90.7%) abnormal findings were detected at DM+BUS, and 65 (100%) at CEM. The inter-reader agreement was excellent (Cohen's k = 0.87 for DM+BUS and 0.97 for CEM). CEM showed a 93.5% sensitivity (vs. 90.3% for DM+BUS), a 79.4-82.4% specificity (vs. 32.4-35.5% for DM+BUS) (McNemar p = 0.006), a 80.6-82.9% PPV (vs. 54.9-56.0% for DM+BUS), a 93.1-93.3% NPV (vs. 78.6-80.0% for DM+BUS), and a 86.1-87.7% accuracy (vs. 60.0-61.5% for DM+BUS). The AUC was higher for CEM than for DM+BUS (0.865 vs. 0.613 for Reader 1, and 0.880 vs. 0.628, for Reader 2) (p < 0.001). In conclusion, CEM had a better diagnostic performance than DM and BUS alone and combined together in patients with dense breasts.
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Affiliation(s)
- Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.G.); (R.M.); (V.R.); (F.C.); (M.P.); (F.P.)
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7
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Bicchierai G, Pugliese F, Amato F, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cossu E, Miele V, Nori J. Percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions): a preliminary single-centre Italian experience. LA RADIOLOGIA MEDICA 2023; 128:528-536. [PMID: 37029852 DOI: 10.1007/s11547-023-01626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE In recent years vacuum-assisted excision (VAE) has been described as an alternative treatment for some B3 lesions. This study aims to assess the effectiveness of using VAE to manage selected B3 lesions by quantifying the number of B3 lesions undergoing VAE, the malignant upgrade rate, and the complications encountered. MATERIALS AND METHODS Our department evaluated all B3 lesions diagnosed between January 2019 and October 2021 and treated them with VAE. The data were collected during the initial biopsy and final histology based on VAE image guidance, also considering initial lesions and complications. The exclusion criteria were: B3 lesion of size > 20 mm, presence of a concomitant malignant lesion, lesion < 5.0 mm distant from the skin, nipple or pectoral muscle, phyllodes tumours or indeterminate B3 lesions. Lesions that upgraded to malignancy underwent surgical excision, while benign lesions performed radiological follow-ups. RESULTS From 416 B3 lesions diagnosed, 67 (16.1%) underwent VAE. VAE was performed under X-ray (50/67) or ultrasound guidance (17/67). Five cases (7.5%) upgraded to a malignant lesion, 2 ADH, 2 LIN and one papillary lesion that underwent surgery. No malignancy or new lesions has occurred at the site of the VAE, with an average radiological follow-up of 14.9 months. CONCLUSIONS VAE could be a safe and effective pathway for managing selected B3 lesions. Lesions initially subjected to CNB with ADH and LN outcome, before undergoing VAE, should perform a VAB for better tissue characterization and management.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy.
| | - Francesca Pugliese
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Elsa Cossu
- Diagnostic and Interventional Imaging, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
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8
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Hogan MP, Horvat JV, Ross DS, Sevilimedu V, Jochelson MS, Kirstein LJ, Goldfarb SB, Comstock CE, Sung JS. Contrast-enhanced mammography in the assessment of residual disease after neoadjuvant treatment. Breast Cancer Res Treat 2023; 198:349-359. [PMID: 36754936 PMCID: PMC10375516 DOI: 10.1007/s10549-023-06865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE To investigate the utility of contrast-enhanced mammography (CEM) as an alternative to breast MRI for the evaluation of residual disease after neoadjuvant treatment (NAT). METHODS This prospective study enrolled consecutive women undergoing NAT for breast cancer from July 2017-July 2019. Breast MRI and CEM exams performed after completion of NAT were read independently by two breast radiologists. Residual disease and lesion size on MRI and CEM recombined (RI) and low-energy images (LEI) were compared. Histopathology was considered the reference standard. Statistical analysis was performed using McNemar's and Leisenring's tests. Multiple comparison adjustment was made using Bonferroni procedure. Lesion sizes were correlated using Kendall's tau coefficient. RESULTS There were 110 participants with 115 breast cancers. Residual disease (invasive cancer or ductal carcinoma in situ) was detected in 83/115 (72%) lesions on pathology, 71/115 (62%) on MRI, 55/115 (48%) on CEM RI, and 75/115 (65%) on CEM LEI. When using multiple comparison adjustment, no significant differences were detected between MRI combined with CEM LEI and CEM RI combined with CEM LEI, in terms of accuracy (MRI: 77%, CEM: 72%; p ≥ 0.99), sensitivity (MRI: 88%, CEM: 81%; p ≥ 0.99), specificity (MRI: 47%, CEM: 50%; p ≥ 0.99), PPV (MRI: 81%, CEM: 81%; p ≥ 0.99), or NPV (MRI: 60%, CEM: 50%; p ≥ 0.99). Size correlation between pathology and both MRI combined with CEM LEI and CEM RI combined with CEM LEI was moderate: τ = 0. 36 vs 0.33 (p ≥ 0.99). CONCLUSION Contrast-enhanced mammography is an acceptable alternative to breast MRI for the detection of residual disease after neoadjuvant treatment.
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Affiliation(s)
- Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Dara S Ross
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10017, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Laurie J Kirstein
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Shari B Goldfarb
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Christopher E Comstock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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9
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Migliaro G, Bicchierai G, Valente P, Di Naro F, De Benedetto D, Amato F, Boeri C, Vanzi E, Miele V, Nori J. Contrast Enhanced Mammography (CEM) Enhancing Asymmetry: Single-Center First Case Analysis. Diagnostics (Basel) 2023; 13:diagnostics13061011. [PMID: 36980319 PMCID: PMC10047777 DOI: 10.3390/diagnostics13061011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
(1) Purpose: The latest Breast Imaging Reporting and Data System (BI-RADS) lexicon for CEM introduced a new descriptor, enhancing asymmetries (EAs). The purpose of this study was to determine which types of lesions were correlated with EAs. (2) Methods: A total of 3359 CEM exams, executed at AOUC Careggi in Florence, Italy between 2019 and 2021 were retrospectively assessed by two radiologists. For each of the EAs found, the size, the enhancing conspicuity (degree of enhancement relative to background described as low, moderate, or high), whether there was a corresponding finding in the traditional radiology images (US or mammography), the biopsy results when performed including any follow-up exams, and the presence of background parenchymal enhancement (BPE) of the normal breast tissue (minimal, mild, moderate, marked) were described. (3) Results: A total of 64 women were included, 36 of them underwent CEM for a preoperative staging assessment, and 28 for a problem-solving examination. Among the 64 EAs, 19/64 (29.69%) resulted in being category B5 (B5) lesions, 5/64 (7.81%) as category B3 (B3) lesions, and 40/64(62.50%) were negative or benign either after biopsy or second-look exams or follow-up. We assessed that EAs with higher enhancing conspicuity correlated significantly with a higher risk of B5 lesions (p: 0.0071), especially bigger ones (p: 0.0274). Conclusions: EAs can relate both with benign and tumoral lesions, and they need to be assessed as the other CEM descriptors, with re-evaluation of low-energy images and second-look exams, particularly larger EAs with higher enhancing conspicuity.
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Affiliation(s)
- Giuliano Migliaro
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Giulia Bicchierai
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
- Correspondence:
| | - Pietro Valente
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Federica Di Naro
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Diego De Benedetto
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Francesco Amato
- Breast Imaging Diagnostic Unit, Radiology Department, Ospedale San Giovanni di Dio, 92100 Agrigento, Italy
| | - Cecilia Boeri
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Ermanno Vanzi
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Jacopo Nori
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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10
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Phillips J, U Achibiri J, Kim G, Quintana LM, J Mehta R, S Mehta T. Characterization of True and False Positive Findings on Contrast-Enhanced Mammography. Acad Radiol 2022; 29:1672-1681. [PMID: 35190261 DOI: 10.1016/j.acra.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this paper is to characterize true and false positive findings on contrast-enhanced mammography (CEM) and correlate enhancement pattern and method of detection with pathology outcomes. MATERIALS AND METHODS This was an IRB-approved retrospective review of diagnostic CEM performed from December 2015 through December 2019 for which biopsy was recommended. Background parenchymal enhancement, tissue density, finding features, pathologic/clinical outcomes, and method of detection were captured. CEM includes low-energy images (LE), similar to standard 2D mammography, and recombined images (RI) that show enhancement. 'MG-detected' findings were identified on mammography or LE. 'RI-detected' findings were identified due to enhancement on RI. The positive predictive value (PPV2) was calculated on a per-case and a per-finding level. Comparisons were performed using Pearson chi-square and Fisher exact tests. RESULTS One hundred sixty CEM cases with 220 findings were evaluated with a case PPV2 of 58.1%. 32.3% (71/220) of lesions were RI-detected. The PPV2 of RI-detected enhancement was 40.8% with subanalysis revealing PPV2 of 22.2%, 32%, and 51.4% for foci, NME, and masses, respectively. The PPV2 of MG-detected enhancement was 73.5% with subanalysis revealing PPV2 of 50%, 54.1%, and 83.8% for foci, NME, and masses, respectively. There were 100 false positives findings, 42 of which were RI-detected. CONCLUSION PPV2 of diagnostic CEM is within the range of other diagnostic breast imaging exams. However false positives remain a challenge, especially for RI-detected findings. Additional efforts to improve specificity of RI-detected findings are worthwhile.
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Affiliation(s)
- Jordana Phillips
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Janeiro U Achibiri
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Geunwon Kim
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Liza M Quintana
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Rashmi J Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Tejas S Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
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11
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Impact of contrast-enhanced mammography in surgical management of breast cancers for women with dense breasts: a dual-center, multi-disciplinary study in Asia. Eur Radiol 2022; 32:8226-8237. [PMID: 35788756 DOI: 10.1007/s00330-022-08906-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the impact of pre-operative contrast-enhanced mammography (CEM) in breast cancer patients with dense breasts. METHODS We conducted a retrospective review of 232 histologically proven breast cancers in 200 women (mean age: 53.4 years ± 10.2) who underwent pre-surgical CEM imaging across two Asian institutions (Singapore and Taiwan). Majority (95.5%) of patients had dense breast tissue (BI-RADS category C or D). Surgical decision was recorded in a simulated blinded multi-disciplinary team setting on two separate scenarios: (i) pre-CEM setting with standard imaging, and clinical and histopathological results; and (ii) post-CEM setting with new imaging and corresponding histological findings from CEM. Alterations in surgical plan (if any) because of CEM imaging were recorded. Predictors CEM of patients who benefitted from surgical plan alterations were evaluated using logistic regression. RESULTS CEM resulted in altered surgical plans in 36 (18%) of 200 patients in this study. CEM discovered clinically significant larger tumor size or extent in 24 (12%) patients and additional tumors in 12 (6%) patients. CEM also detected additional benign/false-positive lesions in 13 (6.5%) of the 200 patients. Significant predictors of patients who benefitted from surgical alterations found on multivariate analysis were pre-CEM surgical decision for upfront breast conservation (OR, 7.7; 95% CI, 1.9-32.1; p = 0.005), architectural distortion on mammograms (OR, 7.6; 95% CI, 1.3-42.9; p = .022), and tumor size of ≥ 1.5 cm (OR, 1.5; 95% CI, 1.0-2.2; p = .034). CONCLUSION CEM is an effective imaging technique for pre-surgical planning for Asian breast cancer patients with dense breasts. KEY POINTS • CEM significantly altered surgical plans in 18% (nearly 1 in 5) of this Asian study cohort with dense breasts. • Significant patient and imaging predictors for surgical plan alteration include (i) patients considered for upfront breast-conserving surgery; (ii) architectural distortion lesions; and (iii) tumor size of ≥ 1.5 cm. • Additional false-positive/benign lesions detected through CEM were uncommon, affecting only 6.5% of the study cohort.
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12
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Montrognon F, Clatot F, Berghian A, Douvrin F, Quieffin F, Defta D, Buquet A, Ferret M, Lequesne J, Leheurteur M, Fontanilles M, Georgescu D, Callonnec F. Impact of preoperative staging with contrast-enhanced mammography for localized breast cancer management. Br J Radiol 2022; 95:20210765. [PMID: 35195454 PMCID: PMC10996426 DOI: 10.1259/bjr.20210765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A precise evaluation of the disease extent is mandatory before surgery for early breast cancer (EBC). Contrast-enhanced mammography (CEDM) is a recent technique that may help define adequate surgery. METHODS This retrospective study included consecutive patients referred to a cancer center between November 2016 and July 2017 for biopsy-confirmed invasive EBC management. The primary objective was to evaluate the rate of surgical changes after incorporating the results of the preoperative staging examination, including CEDM. RESULTS A total of 231 patients were screened for inclusion, and 132 patients were included, corresponding to 134 lesions. The first surgical plan was modified for 33 patients (25%), which represented 34 lesions. For 8 patients (6%), the surgery was cancelled in preference for neoadjuvant chemotherapy; for 16 patients (12.1%), the primary tumor procedure was enlarged; and for 23 patients (17.4%) the lymph node management was modified. Surgery was changed only due to the CEDM results for 24 patients (18.5%) and consisted of a more invasive procedure due to a more extended, multifocal or multicentric lesion than seen on the standard imaging. Anatomopathological surgery piece findings were well correlated with contrast-enhanced mammography results. Overall, there was no increase in the delay between the planned date of surgery and the effective surgical procedure (median 0 days). CONCLUSION CEDM added to preoperative staging helped define better surgical management without increasing delay in the surgical procedure. ADVANCES IN KNOWLEDGE CEDM is a reliable technique that should be considered as part of preoperative staging for EBC.
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Affiliation(s)
- Fanny Montrognon
- Department of Radiology, University Hospital
Center, Rouen,
France
| | - Florian Clatot
- Department of Medical Oncology, Henri Becquerel
Center, Rouen,
France
| | - Anca Berghian
- Department of Anatomopathology, Henri Becquerel
Center, Rouen,
France
| | | | | | - Diana Defta
- Department of Radiology, Henri Becquerel Center,
Rouen, France
| | - Anaïs Buquet
- Department of Radiology, Henri Becquerel Center,
Rouen, France
| | - Martine Ferret
- Department of Radiology, Henri Becquerel Center,
Rouen, France
| | - Justine Lequesne
- Department of Clinical Research, Henri Becquerel
Center, Rouen,
France
| | | | | | - Dragos Georgescu
- Department of Gynecology and Breast surgery, Henri Becquerel
Center, Rouen,
France
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13
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Bellini C, Bicchierai G, Amato F, Savi E, De Benedetto D, Di Naro F, Boeri C, Vanzi E, Miele V, Nori J. Comparison between second-look ultrasound and second-look digital breast tomosynthesis in the detection of additional lesions with presurgical CESM. Br J Radiol 2022; 95:20210927. [PMID: 35451312 PMCID: PMC10996408 DOI: 10.1259/bjr.20210927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare second-look ultrasound (SL-ultrasound) with second-look digital breast tomosynthesis (SL-DBT) in the detection of additional lesions (ALs) with presurgical contrast-enhanced spectral mammography (CESM). METHODS We retrospectively included 121 women with 128 ALs from patients who underwent CESM for presurgical staging at our centre from September 2016 to December 2018. These ALs underwent SL-ultrasound and a retrospective review of DBT (SL-DBT) performed 1-3 weeks prior to CESM to evaluate the performance of each technique individually and in combination. ALs in CESM images were evaluated according to enhancement type (focus, mass, or non-mass), size (<10 mm or >10 mm) and level of suspicion (BI-RADS 2, 3, 4 or 5). Our gold-standard was post-biopsy histology, post-surgical specimen or >24 month negative follow-up. McNemar's test was used for the statistical analysis. RESULTS Out of the 128 ALs, an imaging correlate was found for 71 (55.5 %) with ultrasound, 79 (61.7%) with DBT, 53 (41.4 %) with DBT and ultrasound, and 97 (75.8%) with ultrasound and/or DBT. SL-DBT demonstrated a higher detection rate vs SL-ultrasound in non-mass enhancement (NME) pattern (p: 0.0325) and ductal carcinoma in situ histological type (p: 0.0081). Adding SL-DBT improved the performance vs SL-ultrasound alone in the overall sample (p: <0.0001) and in every subcategory identified; adding SL-ultrasound to SL-DBT improved the detectability of ALs in the overall sample and in every category except for NME (p: 0.0833), foci (p: 0.0833) and B3 lesions (p: 0.3173). CONCLUSION Combined second-look imaging (SL-DBT+ SL-ultrasound) for CESM ALs is superior to SL-DBT alone and SL-ultrasound alone. In B3 lesions, NME, and foci, the analysis of a larger sample could determine whether adding SL-ultrasound to SL-DBT is necessary or not. ADVANCES IN KNOWLEDGE Thanks to its high sensitivity, CESM is a useful tool in presurgical staging to detect the extent of the disease burden and identify ALs not detected with conventional imaging. Since CESM-guided biopsy systems are still scarcely available in clinical practice, it is necessary to look for other approaches to histologically characterize ALs detected with CESM. In our study, combined second-look imaging (SL-DBT + SL-ultrasound) showed better performance in terms of detectability of ALs, than either SL-DBT or SL-ultrasound alone, and allowed us to identify 91.2% of ALs that turned out to be malignant at final histology; for the remaining 8.8% it was still necessary to perform MRI or MRI-guided biopsy. However, this issue could be solved once CESM-guided biopsies spread in clinical practice. SL-DBT demonstrated a higher detection rate than SL-ultrasound in NME and ductal carcinoma in situ histology.
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Affiliation(s)
- Chiara Bellini
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Francesco Amato
- Diagnostic Senology Unit – Radiology Dpt.,
“Ospedale San Giovanni di Dio”,
Agrigento, Italy
| | - Elena Savi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria
Careggi, Florence,
Italy
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14
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Bicchierai G, Busoni S, Tortoli P, Bettarini S, Naro FD, De Benedetto D, Savi E, Bellini C, Miele V, Nori J. Single Center Evaluation of Comparative Breast Radiation dose of Contrast Enhanced Digital Mammography (CEDM), Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT). Acad Radiol 2022; 29:1342-1349. [PMID: 35065889 DOI: 10.1016/j.acra.2021.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this retrospective study is to compare the radiation dose received during CEDM, short and long protocol (CEDM SP and CEDM LP), with dose received during DM and DBT on patients with varying breast thickness, age and density. MATERIALS AND METHODS Between January 2019 and December 2019, patients having 6214 DM, 3662 DBT and 173 CEDM examinations in our department were analyzed. Protocol total single breast AGD has been evaluated for all clinical imaging protocols, extracting AGD values and exposure data from the dose DICOM Structured Report (SR) information stored in the hospital PACS system. Protocol AGD was calculated as the sum of single projection AGDs carried out in every exam for each clinical protocol. A total amount of 23,383 exams for each breast were analyzed. Protocol AGDs, stratified as a function of patient breast compression thickness, age, and breast density were assessed. RESULTS The total protocol AGD median values for each protocol are: 2.8 mGy for DM, 3.2 mGy for DBT, 6.0 mGy for DM+DBT, 4.5 mGy for CEDM SP, 7.4 mGy for CEDM SP_DBT (CEDM SP protocol with DBT), 8.4 mGy for CEDM LP and 11.6 mGy for CEDM LP_DBT (CEDM LP protocol with DBT). CEDM SP AGD median value is 59% higher than DM AGD median value and 40% lesser than DM+DBT AGD median; this last difference was statistically confirmed with a p-value <0.001. AGD value for each standard breast CEDM SP projection results to be below 3-mGy limit. AGD value for each standard breast CEDM SP projection results to be below 3 mGy, as required by international legislation. For dense breasts, the AGD median value is 4.2 mGy, with the first and third quartile of 3.3 mGy and 6.0 mGy respectively; for non-dense breasts, the AGD median value is 4.7 mGy, with first and third quartile of 3.5 mGy and 6.3 mGy respectively. The difference between the two groups was statistically tested and confirmed, with a p-value of 0.039. CONCLUSION CEDM SP results in higher radiation exposure compared with conventional DM and DBT but lower than the Combo mode. The dose administered during the CEDM SP is lower in patients with dense breasts regardless of their size. An interesting outcome, considering the ongoing studies on CEDM screening in patients with dense breasts.
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15
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Hashem LMB, Sawy YAE, Kamal RM, Ahmed SM, elmesidy DS. The additive role of dynamic contrast-enhanced and diffusion-weighted MR imaging in preoperative staging of breast cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In women with diagnosed breast cancer, accurate loco-regional staging and preoperative examination are of utmost importance for optimal patient management decisions. MRI may be warranted for correct preoperative staging as recommended from international guidelines. DWI-MRI can be combined with CE-MRI to assess more functional data. So we aimed to evaluate the performance of CE-MRI and qualitative DWI-MRI in preoperative loco-regional staging of malignant breast lesions as regards the local extension of the disease and axillary lymph node status, beyond standard assessment with mammography and ultrasound. This prospective study included 50 female patients with pathologically proven malignant breast lesions (BIRADS VI) coming for preoperative staging. Full-field digital mammography (FFDM) and ultrasound, CE-MRI, and DWI-MRI findings were compared for all patients, and the findings were evaluated independently. Results were then correlated to postoperative histopathology.
Results
Fifty women with pathologically proven malignant breast lesions (BIRADS VI) were enrolled in this study; the mean age of this study population was 43.25 years. The 50 patients were divided into 2 groups: 37/50 (74%) underwent upfront surgery and 13/50 (26%) received neoadjuvant therapy before surgery. All patients performed DCE and DWI-MRI breast. Among patients who underwent upfront surgery, DCE-MRI showed the highest correlation with the postoperative pathology size and the overall sensitivity regarding multiplicity. Regarding patients who received neoadjuvant therapy, DCE-MRI was found to have the highest correlation with the postoperative pathology concerning lesion size and multiplicity after completion of the neoadjuvant chemotherapy cycles.
Conclusion
CE-MRI can accurately map lesion extension and detect multifocality/multicentricity, thus tailor surgical management options (either conservative surgery or mastectomy). Qualitative DWI can be combined with ultrasonography for better evaluation of the axillary nodal status.
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16
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The diagnostic value of contrast-enhanced 2D mammography in everyday clinical use. Sci Rep 2021; 11:22224. [PMID: 34782698 PMCID: PMC8593172 DOI: 10.1038/s41598-021-01622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022] Open
Abstract
Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.
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17
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Neeter LM, Raat H(F, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. Contrast-enhanced mammography: what the radiologist needs to know. BJR Open 2021; 3:20210034. [PMID: 34877457 PMCID: PMC8611680 DOI: 10.1259/bjro.20210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.
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Affiliation(s)
| | - H.P.J. (Frank) Raat
- Department of Medical Imaging, Laurentius Hospital, Roermond, the Netherlands
| | | | - Quirien Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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18
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Girometti R, Linda A, Conte P, Lorenzon M, De Serio I, Jerman K, Londero V, Zuiani C. Multireader comparison of contrast-enhanced mammography versus the combination of digital mammography and digital breast tomosynthesis in the preoperative assessment of breast cancer. Radiol Med 2021; 126:1407-1414. [PMID: 34302599 DOI: 10.1007/s11547-021-01400-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare preoperative contrast-enhanced spectral mammography (CEM) versus digital mammography plus digital breast tomosynthesis (DM + DBT) in detecting breast cancer (BC) and assessing its size. MATERIAL AND METHODS We retrospectively included 78 patients with histological diagnosis of BC who underwent preoperative DM, DBT, and CEM over one year. Four readers, blinded to pathology and clinical information, independently evaluated DM + DBT versus CEM to detect BC and measure its size. Readers' experience ranged 3-10 years. We calculated the per-lesion cancer detection rate (CDR) and the complement of positive predictive value (1-PPV) of both methods, stratifying analysis on the total of lesions, index lesions, and additional lesions. The agreement in assessing cancer size versus pathology was assessed with Bland-Altman analysis. RESULTS 100 invasive BCs (78 index lesions and 22 additional lesions) were analyzed. Compared to DM + DBT, CEM showed higher overall CDR in less experienced readers (range 0.85-0.90 vs. 0.95-0.96), and higher CDR for additional lesions, regardless of the reader (range 0.54-0.68 vs. 0.77-0.86). CEM increased the detection of additional disease in dense breasts in all readers and non-dense breasts in less experienced readers only. The 1-PPV of CEM (range 0.10-0.18) was comparable to that of DM + DBT (range 0.09-0.19). At Bland-Altman analysis, DM + DBT and CEM showed comparable mean differences and limits of agreement in respect of pathologic cancer size. CONCLUSION Preoperative CEM improved the detection of additional cancer lesions compared to DM + DBT, particularly in dense breasts. CEM and DM + DBT achieved comparable performance in cancer size assessment.
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Affiliation(s)
- Rossano Girometti
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Anna Linda
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Paola Conte
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Michele Lorenzon
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Isabella De Serio
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Katerina Jerman
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Viviana Londero
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Chiara Zuiani
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy.
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A Review of Breast Imaging for Timely Diagnosis of Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115509. [PMID: 34063854 PMCID: PMC8196652 DOI: 10.3390/ijerph18115509] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022]
Abstract
Breast cancer (BC) is the cancer with the highest incidence in women in the world. In this last period, the COVID-19 pandemic has caused in many cases a drastic reduction of routine breast imaging activity due to the combination of various factors. The survival of BC is directly proportional to the earliness of diagnosis, and especially during this period, it is at least fundamental to remember that a diagnostic delay of even just three months could affect BC outcomes. In this article we will review the state of the art of breast imaging, starting from morphological imaging, i.e., mammography, tomosynthesis, ultrasound and magnetic resonance imaging and contrast-enhanced mammography, and their most recent evolutions; and ending with functional images, i.e., magnetic resonance imaging and contrast enhanced mammography.
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20
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Kim G, Patel B, Mehta TS, Du L, Mehta RJ, Phillips J. Contrast-enhanced Mammography: A Guide to Setting Up a New Clinical Program. JOURNAL OF BREAST IMAGING 2021; 3:369-376. [PMID: 38424777 DOI: 10.1093/jbi/wbab027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 03/02/2024]
Abstract
Contrast-enhanced mammography (CEM) is gaining rapid traction following the U.S. Food and Drug Administration approval for diagnostic indications. Contrast-enhanced mammography is an alternative form of mammography that uses a dual-energy technique for image acquisition after the intravenous administration of iodinated contrast material. The resulting exam includes a dual set of images, one that appears similar to a routine 2D mammogram and one that highlights areas of contrast uptake. Studies have shown improved sensitivity compared to mammography and similar performance to contrast-enhanced breast MRI. As radiology groups incorporate CEM into clinical practice they must first select the indications for which CEM will be used. Many practices initially use CEM as an MRI alternative or in cases recommended for biopsy. Practices should then define the CEM clinical workflow and patient selection to include ordering, scheduling, contrast safety screening, and managing imaging on the day of the exam. The main equipment requirements for performing CEM include CEM-capable mammography equipment, a power injector for contrast administration, and imaging-viewing capability. The main staffing requirements include personnel to place the intravenous line, perform the CEM exam, and interpret the CEM. To safely and appropriately perform CEM, staff must be trained in their respective roles and to manage potential contrast-related events. Lastly, informing referring colleagues and patients of CEM through marketing campaigns is helpful for successful implementation.
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Affiliation(s)
- Geunwon Kim
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Bhavika Patel
- Mayo Clinic Hospital, Department of Radiology, Phoenix, AZ, USA
| | - Tejas S Mehta
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Linda Du
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Rashmi J Mehta
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Jordana Phillips
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
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Teh J, Kessell M, Dissanayake D, Wylie EJ. Vascular injuries detected on contrast-enhanced mammography following vacuum-assisted breast biopsy. Breast J 2020; 26:2302-2304. [PMID: 32860291 DOI: 10.1111/tbj.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Joelin Teh
- Department of Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - Meredith Kessell
- Department of Radiology, Royal Perth Hospital, Perth, WA, Australia
| | | | - Elizabeth J Wylie
- Department of Radiology, Royal Perth Hospital, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, Australia
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22
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Bicchierai G, Amato F, Vanzi B, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cirone D, Cozzi D, Miele V, Nori J. Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)? Breast 2020; 54:15-24. [PMID: 32889303 PMCID: PMC7479440 DOI: 10.1016/j.breast.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background CEDM has demonstrated a diagnostic performance similar to MRI and could have similar limitations in breast cancer (BC) detection. Purpose The aim of our study was to systematically analyze the characteristics of the lesions with the absence of enhancement with CEDMs, called false-negatives (FNs), in order to identify which clinical, radiological, histological and molecular parameters are associated with the absence of enhancement of known BCs with CEDMs, and which types of BC are most likely to cause FNs in CEDMs. We also tried to evaluate which parameters instead increased the probability of showing enhancement in the same context. Materials and methods Included in our study group were 348 women with 348 diagnosed BCs performing CEDM as preoperative staging. Two breast-imaging radiologists reviewed the CEDM exams. The absence of perceptible contrast enhancement at the index cancer site was indicative of an FN CEDM, whereas cases with appreciable enhancement were considered true positives (TPs). Dichotomic variables were analyzed with Fisher’s exact probability test or, when applicable, the chi-square test. Binary logistic regression was performed on variables shown to be significant by the univariate analysis in order to assess the relationship between predictors (independent variables) and TFNs (outcome). Results Enhancement was observed in 317 (91.1%) of the 348 BCs. From the 31 (8.9%) lesions which were FNs, we excluded 12 (38.7%) which showed an artifact generated by the post biopsy hematoma and 6 (19.4%) which were outside the CEDM field of vision. We thus obtained 13 (41.9%) BCs considered “True False Negatives” (TFNs), i.e. BCs which showed no enhancement despite being within the CEDM field of vision and failed to show post biopsy hematoma artifacts. We found that the TFNs frequently have a unifocal disease extension, diameter <10 mm, a lower number of luminal B HER2-subtypes, a higher number of DCIS, and an index lesion with microcalcifications. Conclusions The parameters we found to be associated with no enhancement of known BCs with CEDMs were: unifocal disease extension, DCIS histotype, lesion dimensions <10 mm, and index lesion with microcalcifications. The characteristics that instead increase the probability of showing enhancement were US mass, Luminal B HER2 negative molecular subtype, the presence of an invasive ductal component, and lesion dimensions ≥10 mm. The variables associated with an increased risk of no enhancement were unifocal disease extension, non-classifiable molecular subtype, DCIS histotype, lesion dimensions <10 mm, index lesion represented by microcalcifications. A greater probability of showing enhancement entailed the presence of an invasive ductal component, index lesion represented by ultrasound mass, Luminal B HER2 negative molecular subtype, lesion dimensions ≥10 mm, multifocal disease extension.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
| | - Bianca Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Donatello Cirone
- General Management Staff, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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